12 Diversity and Inclusion – Aging and the Elderly
Chapter Outline
9-year old twins Osiris and Joli loved making meals with Bibi, their grandmother. Osiris loved the cooking; Joli loved stealing the ingredients. The kids didn’t get very involved with the chicken, but perked up with the fufu and almost took over the dough balls. Bibi yelled at Joli to stop eating raw batter, but she didn’t mean it.
Bibi loved having them around. She sang mash-ups of 90s songs and big band music, mixing in funny mentions of their day-to-day lives. As she prepped the cassava, she’d throw the discarded pieces in a waste bowl like she was playing basketball. Bibi told them a story about how one of her schoolteachers was was so young that all the students thought she was one of them. “So when she told us her last name, I thought it was her first name and called her by it. So she sent me outside for punishment!”
The kids burst into peals of laughter. Bibi joined in as she moved a pan.
Suddenly the stove erupted in flame. The oil in the pan had spilled over. Bibi grabbed a glass of water on the table. Joli screamed at her to stop, but Bibi had already thrown the water onto the oil. The flames flared and splattered across the stove and onto the counter. A paper towel caught fire. Everyone was screaming. Osiris and Joli’s mother, Gloria, was in the room a moment later. Pushing Bibi away, she turned off the stove and threw a towel on some of the flames. She took a fire extinguisher from the cabinet and, after a few seconds of fiddling with the pin and hose, emptied it onto the fire.
“Mom!” Gloria yelled. “Why would you put water on an oil fire? You know that’s the last thing to do!”
Bibi, in the corner, seemed to hold on to the wall to remain standing. She shook her head and looked at the children. “It’s a fire. You put water on it.”
“No you don’t. You taught me never to do that. You told me to use salt…anything but water. You could have burned down the house!”
Bibi was crying. She looked at the children and sank toward the floor. “I don’t remember that. I’m so sorry. It’s a fire, I thought. Put water on it.” Gloria sent the children out of the room and sat her mother down.
Aside from the scare from the fire, why might Bibi be crying? What difficulties do older people face in undertaking day-to-day activities? What difficulties do their family members face? In this chapter, we will explore the identities and issues of older people in our societies, and consider our attitudes and obligations toward them.
The Elderly and Aging in Society
Learning Objectives
By the end of this section, you should be able to:
- Differentiate between the major senior age groups (young-old, middle-old, and old-old)
- Describe the “graying of the United States” as the population experiences increased life expectancies
- Examine aging as a global issue
Think of U.S. movies and television shows you have watched recently. Did any of them feature older actors and actresses? What roles did they play? How were these older actors portrayed? Were they cast as main characters in a love story? Did they seem fully capable, safe, productive, and happy? Or were they a challenge to those around them? Were they grouchy or overly set in their ways?
Many media portrayals of the elderly reflect negative cultural attitudes toward aging. In the United States, society tends to glorify youth and associate it with beauty and sexuality. In comedies, the elderly are often associated with grumpiness or hostility. Rarely do the roles of older people convey the fullness of life experienced by seniors—as employees, lovers, or the myriad roles they have in real life. What values does this reflect?
One hindrance to society’s fuller understanding of aging is that people rarely understand the process of aging until they reach old age themselves. This lack of understanding is in stark contrast to our perspective on childhood, something we’ve all experienced. And as is often the case with a lack of knowledge or understanding, it leads to myths, assumptions, and stereotypes about elderly people and the aging process. While stereotypes associated with race and gender may lead to more critical thought and sensitivity, many people accept age stereotypes without question (Levy 2002). Consider this: At your school or workplace, you have likely had the opportunity (or may be required) to attend workshops on racial equity, cultural sensitivity, sexual harassment, and so on. But even though the elderly are all around us (and increasing in number every day), very few institutions conduct similar workshops or forums about the elderly. Each culture has a certain set of expectations and assumptions about aging, all of which are part of our socialization.
While the landmarks of maturing into adulthood are a source of pride, often celebrated at major milestones like First Communion, Bar Mitzvah, or Quinceañera, signs of natural aging can be cause for shame or embarrassment. Some people avoid acknowledging their aging by rejecting help when they need it , which can lead to physical injury or problems obtaining needed items or information. For example, when vaccinations for the COVID-19 virus became available, U.S. seniors who didn’t have help from family and friends lagged significantly in receiving vaccines; this occurred despite of the fact that seniors were known to be the highest risk group and were the most susceptible to illness and death if they were infected (Graham 2021). Those elderly people who were resistant to reach out for help may have waited too long, and their neighbors or other community members may not have known they needed the help. Why would they take this risk? Researchers aim to uncover the motivations and challenges that may result in these circumstances and behavior.
Gerontology is a field of science that seeks to understand the process of aging and the challenges encountered as seniors grow older. Gerontologists investigate age, aging, and the aged. Gerontologists study what it is like to be an older adult in a society and the ways that aging affects members of a society. As a multidisciplinary field, gerontology includes the work of medical and biological scientists, social scientists, and even financial and economic scholars.
Social gerontology refers to a specialized field of gerontology that examines the social (and sociological) aspects of aging. Researchers focus on developing a broad understanding of the experiences of people at specific ages, such as mental and physical wellbeing, plus age-specific concerns such as the process of dying. Social gerontologists work as social researchers, counselors, community organizers, and service providers for older adults. Because of their specialization, social gerontologists are in a strong position to advocate for older adults.
Scholars in these disciplines have learned that “aging” reflects not only the physiological process of growing older but also our attitudes and beliefs about the aging process. You’ve likely seen online calculators that promise to determine your “real age” as opposed to your chronological age. These ads target the notion that people may “feel” a different age than their actual years. Some sixty-year-olds feel frail and elderly, while some eighty-year-olds feel sprightly.
Equally revealing is that as people grow older they define “old age” in terms of greater years than their current age (Logan 1992). Many people want to postpone old age and regard it as a phase that will never arrive. For example, many older Americans keep working well past what people consider retirement age, due to financial pressures or in order to remain, in their eyes, useful. Some older adults even succumb to stereotyping their own age group (Rothbaum 1983).
In the United States, the experience of being elderly has changed greatly over the past century. In the late 1800s and early 1900s, many U.S. households were home to multigenerational families, and the experiences and wisdom of elders was respected. They offered wisdom and support to their children and often helped raise their grandchildren (Sweetser 1984).
Multigenerational U.S. families began to decline after World War II, and their numbers reached a low point around 1980, but they are consistently on the rise. A 2010 Pew Research Center analysis of census data found that 49 million people in the United States lived in a family household with at least two adult generations—or a grandparent and at least one other generation a record at the time. By 2016, that number had grown to 64 million people living in multigenerational households, roughly 20 percent of the population (Cohn 2018).
Attitudes toward the elderly have also been affected by large societal changes that have happened over the past 100 years. Researchers believe industrialization and modernization have contributed greatly to lowering the power, influence, and prestige the elderly once held. On the other hand, the sheer numbers of elderly people in certain societies can have other effects, such as older people’s influence on policies and politics based on their voting influence.
The elderly have both benefited and suffered from these rapid social changes. In modern societies, a strong economy created new levels of prosperity for many people. Healthcare has become more widely accessible, and medicine has advanced, which allows the elderly to live longer. However, older people are not as essential to the economic survival of their families and communities as they were in the past.
Studying Aging Populations
Since its creation in 1790, the U.S. Census Bureau has been tracking age in the population. Age is an important factor to analyze with accompanying demographic figures, such as income and health. The population chart below shows projected age distribution patterns for the next several decades.
Statisticians use data to calculate the median age of a population, that is, the number that marks the halfway point in a group’s age range. In the United States, the median age is about forty (U.S. Census Bureau 2010). That means that about half of the people in the United States are under forty and about half are over forty. This median age has been increasing, which indicates the population as a whole is growing older.
A cohort is a group of people who share a statistical or demographic trait. People belonging to the same age cohort were born in the same time frame. Understanding a population’s age composition can point to certain social and cultural factors and help governments and societies plan for future social and economic challenges.
Sociological studies on aging might help explain the difference between Native American age cohorts and the general population. While Native American societies have a strong tradition of revering their elders, they also have a lower life expectancy because of lack of access to healthcare and high levels of mercury in fish, which is a traditional part of their diet.
Phases of Aging: The Young-Old, Middle-Old, and Old-Old
In the United States, all people over eighteen years old are considered adults, but there is a large difference between a person who is twenty-one years old and a person who is forty-five years old. More specific breakdowns, such as “young adult” and “middle-aged adult,” are helpful. In the same way, groupings are helpful in understanding the elderly. The elderly are often lumped together to include everyone over the age of sixty-five. But a sixty-five-year-old’s experience of life is much different from a ninety-year-old’s.
The United States’ older adult population can be divided into three life-stage subgroups: the young-old (approximately sixty-five to seventy-four years old), the middle-old (ages seventy-five to eighty-four years old), and the old-old (over age eighty-five). Today’s young-old age group is generally happier, healthier, and financially better off than the young-old of previous generations. In the United States, people are better able to prepare for aging because resources are more widely available.
Also, many people are making proactive quality-of-life decisions about their old age while they are still young. In the past, family members made care decisions when an elderly person reached a health crisis, often leaving the elderly person with little choice about what would happen. The elderly are now able to choose housing, for example, that allows them some independence while still providing care when it is needed. Living wills, retirement planning, and medical power of attorney are other concerns that are increasingly handled in advance.
The Graying of the United States
What does it mean to be elderly? Some define it as an issue of physical health, while others simply define it by chronological age. The U.S. government, for example, typically classifies people aged sixty-five years old as elderly, at which point citizens are eligible for federal benefits such as Social Security and Medicare. The World Health Organization has no standard, other than noting that sixty-five years old is the commonly accepted definition in most core nations, but it suggests a cut-off somewhere between fifty and fifty-five years old for semi-peripheral nations, such as those in Africa (World Health Organization 2012). AARP (formerly the American Association of Retired Persons) cites fifty as the eligible age of membership. It is interesting to note AARP’s name change; by taking the word “retired” out of its name, the organization can broaden its base to any older people in the United States, not just retirees. This is especially important now that many people are working to age seventy and beyond.
There is an element of social construction, both local and global, in the way individuals and nations define who is elderly; that is, the shared meaning of the concept of elderly is created through interactions among people in society. As the table demonstrates, different generations have varying perspectives on aging. Researchers asked questions about the ages at which people reach certain milestones or new categories in life. Members of the Baby Boom generation indicate that a person is officially “old” when they turn 73 years old. Millennials, a much younger group, felt that people became old when they turned 59. The same survey asked questions about the end of youth and the prime of life (Emling 2017). Interestingly, Boomers and GenXers both felt that youth “ended” by age 31 and that the prime of life didn’t start until many years later. Millennials felt that people reached the prime of life at age 36, before youth ended at age 40. It’s worth noting that at the time of the survey, the Millennials were all 36 and younger.
| Boomer response | Gen X response | Millennial response | |
|---|---|---|---|
| At what age does youth end? | 31 | 31 | 40 |
| At what age is the prime of life? | 50 | 47 | 36 |
| At what age is someone old? | 73 | 65 | 59 |
Demographically, the U.S. population has undergone a massive shift both in the overall population of elderly people and their share of the total population. Both are significant and impactful on major policy decisions and day-to-day life. In 1900, the population of U.S people over sixty-five years old was 3 million, representing about 4 percent of the total population. That number increased to 33 million in 1994, and was roughly 12 percent of the total population (Hobbs 1994). By 2016 that number had grown to 49 million, about 15 percent of the total population (U.S. Census Bureau 2018). This is a greater than tenfold increase in the elderly population, compared to a mere tripling of both the total population and of the population under sixty-five years old (Hobbs 1994). This increase has been called “the graying of America,” a term that describes the phenomenon of a larger and larger percentage of the population getting older and older. There are several reasons why the United States is graying so rapidly. One of these is life expectancy: the average number of years a person born today may expect to live. When we review Census Bureau statistics grouping the elderly by age, it is clear that in the United States, at least, we are living longer. In 2010, there were about 80,000 centenarians in the United States alone. They make up one of the fastest-growing segments of the population (Boston University School of Medicine 2014).
It is interesting to note that not all people in the United States age equally. Most glaring is the difference between men and women; as Figure 13.6 shows, women have longer life expectancies than men. In 2010, there were ninety sixty-five-year-old men per one hundred sixty-five-year-old women. However, there were only eighty seventy-five-year-old men per one hundred seventy-five-year-old women, and only sixty eighty-five-year-old men per one hundred eighty-five-year-old women. Nevertheless, as the graph shows, the sex ratio actually increased over time, indicating that men are closing the gap between their life spans and those of women (U.S. Census Bureau 2010).
Baby Boomers
Of particular interest to gerontologists today is the population of Baby Boomers, the cohort born between 1946 and 1964 and now reaching their 60s and 70s. Coming of age in the 1960s and early 1970s, the baby boom generation was the first group of children and teenagers with their own spending power and therefore their own marketing power (Macunovich 2000). As this group has aged, it has redefined what it means to be young, middle-aged, and now old. People in the Boomer generation do not want to grow old the way their grandparents did; the result is a wide range of products designed to ward off the effects—or the signs—of aging. Previous generations of people over sixty-five were “old.” Baby Boomers are in “later life” or “the third age” (Gilleard and Higgs 2007).
The baby boom generation is the cohort driving much of the dramatic increase in the over-sixty-five population. Figure 13.7 shows a comparison of the U.S. population by age and gender between 2000 and 2010. The biggest bulge in the pyramid (representing the largest population group) moves up the pyramid over the course of the decade; in 2000, the largest population group was age thirty-five to fifty-five. In 2010, that group was age forty-five to sixty-five, meaning the oldest baby Boomers were just reaching the age at which the U.S. Census considers them elderly. By 2030, all Baby Boomers will be age 65 and older, and represent the largest group of elderly people.
This aging of the Baby Boom cohort has serious implications for our society. Healthcare is one of the areas most impacted by this trend. According to the U.S. Department of Health and Human Services, healthcare spending is projected to grow by 5.5 percent each year from now until 2027. The portion of government spending on Medicare (a program in which the government covers some costs of healthcare for the elderly) is expected to increase from 3 percent of gross domestic product (GDP) in 2009 to 8 percent of GDP in 2030, and to 15 percent in 2080 (CMS 2018).
Certainly, as Boomers age, they will put increasing burdens on the entire U.S. healthcare system. The American Geriatrics Society notes that from 2013-2025, there will be a 45 percent increase in demand for physicians who specialize in geriatrics. As a result, over 33,000 specialists will be needed to fill the healthcare needs in 2025. And in 2020, there were only 6,320 such specialists in the United States (AGS 2021).
Unlike the elderly of previous generations, Boomers do not expect that turning sixty-five means their active lives are over. They are not willing to abandon work or leisure activities, but they may need more medical support to keep living vigorous lives. This desire of a large group of over-sixty-five-year-olds wanting to continue with a high activity level is driving innovation in the medical industry (Shaw n.d.).
The economic impact of aging Boomers is also an area of concern for many observers. Although the baby boom generation earned more than previous generations and enjoyed a higher standard of living, they did not adequately prepare for retirement. According to most retirement and investment experts, in order to maintain their accustomed lifestyle, people need to save ten times their annual income before retiring. (Note: That’s income, not salary.) So if a person has an income of $60,000 per year, they should have saved $600,000. If they made $100,000 per year, they should have saved $1 million. But most Baby Boomers have only saved an estimated $144,000, and only 40 percent have saved more than $250,000 (Gravier 2021). The causes of these shortfalls are varied, and include everything from lavish spending to economic recession to companies folding and reducing pension payments. Higher education costs increased significantly while many Baby Boomers were sending their children to college. No matter what the cause, many retirees report a great deal of stress about running out of money.
Just as some observers are concerned about the possibility of Medicare being overburdened, Social Security is considered to be at risk. Social Security is a government-run retirement program funded primarily through payroll taxes. With enough people paying into the program, there should be enough money for retirees to take out. But with the aging Boomer cohort starting to receive Social Security benefits and fewer workers paying into the Social Security trust fund, economists warn that the system will collapse by the year 2037. A similar warning came in the 1980s; in response to recommendations from the Greenspan Commission, the retirement age (the age at which people could start receiving Social Security benefits) was raised from sixty-two to sixty-seven and the payroll tax was increased. A similar hike in retirement age, perhaps to seventy, is a possible solution to the current threat to Social Security.
Aging around the World
The United States is certainly not alone regarding its aging population; in fact, it doesn’t even have the fastest-growing group of elderly people. In 2019, the world had 703 million people aged 65 years or over. By 2050, that number is projected to double to 1.5 billion. One in six people in the world will be 65 or over (United Nations 2020).
This percentage is expected to increase and will have a huge impact on the dependency ratio: the number of citizens not in the labor force (young, disabled, or elderly) to citizens in the labor force (Bartram and Roe 2005). One country that will soon face a serious aging crisis is China, which is on the cusp of an “aging boom”— a period when its elderly population will dramatically increase. The number of people above age sixty in China today is about 178 million, which amounts to 13.3 percent of its total population (Xuequan 2011). By 2050, nearly a third of the Chinese population will be age sixty or older, which will put a significant burden on the labor force and impact China’s economic growth (Bannister, Bloom, and Rosenberg 2010). On a more global scale, the dependency ratio is projected to more than double in Eastern and South-Eastern Asia, Latin America and the Caribbean, Northern Africa and Western Asia, and Central and Southern Asia.
As healthcare improves and life expectancy increases across the world, elder care will be an emerging issue. Wienclaw (2009) suggests that with fewer working-age citizens available to provide home care and long-term assisted care to the elderly, the costs of elder care will increase.
Worldwide, the expectation governing the amount and type of elder care varies from culture to culture. For example, in Asia the responsibility for elder care lies firmly on the family (Yap, Thang, and Traphagan 2005). This is different from the approach in most Western countries, where the elderly are considered independent and are expected to tend to their own care. It is not uncommon for family members to intervene only if the elderly relative requires assistance, often due to poor health. Even then, caring for the elderly is considered voluntary. In the United States, decisions to care for an elderly relative are often conditionally based on the promise of future returns, such as inheritance or, in some cases, the amount of support the elderly provided to the caregiver in the past (Hashimoto 1996).
These differences are based on cultural attitudes toward aging. In China, several studies have noted the attitude of filial piety (deference and respect to one’s parents and ancestors in all things) as defining all other virtues (Hsu 1971; Hamilton 1990). Cultural attitudes in Japan prior to approximately 1986 supported the idea that the elderly deserve assistance (Ogawa and Retherford 1993). However, seismic shifts in major social institutions (like family and economy) have created an increased demand for community and government care. For example, the increase in women working outside the home has made it more difficult to provide in-home care to aging parents, which leads to an increase in the need for government-supported institutions (Raikhola and Kuroki 2009).
In the United States, by contrast, many people view caring for the elderly as a burden. Even when there is a family member able and willing to provide for an elderly family member, 60 percent of family caregivers are employed outside the home and are unable to provide the needed support. At the same time, however, many middle-class families are unable to bear the financial burden of “outsourcing” professional healthcare, resulting in gaps in care (Bookman and Kimbrel 2011). It is important to note that even within the United States not all demographic groups treat aging the same way. While most people in the United States are reluctant to place their elderly members into out-of-home assisted care, demographically speaking, the groups least likely to do so are Latinos, African Americans, and Asians (Bookman and Kimbrel 2011).
Globally, the United States and other core nations are fairly well equipped to handle the demands of an exponentially increasing elderly population. However, peripheral and semi-peripheral nations face similar increases without comparable resources. Poverty among elders is a concern, especially among elderly women. The feminization of the aging poor, evident in peripheral nations, is directly due to the number of elderly women in those countries who are single, illiterate, and not a part of the labor force (Mujahid 2006).
In 2002, the Second World Assembly on Aging was held in Madrid, Spain, resulting in the Madrid Plan, an internationally coordinated effort to create comprehensive social policies to address the needs of the worldwide aging population. The plan identifies three themes to guide international policy on aging: 1) publicly acknowledging the global challenges caused by, and the global opportunities created by, a rising global population; 2) empowering the elderly; and 3) linking international policies on aging to international policies on development (Zelenev 2008).
The Madrid Plan has not yet been successful in achieving all its aims. However, it has increased awareness of the various issues associated with a global aging population, as well as raising the international consciousness to the way that the factors influencing the vulnerability of the elderly (social exclusion, prejudice and discrimination, and a lack of socio-legal protection) overlap with other developmental issues (basic human rights, empowerment, and participation), leading to an increase in legal protections (Zelenev 2008).
Challenges Facing the Elderly
Learning Objectives
By the end of this section, you should be able to:
- Interpret the historical and current trends of poverty among elderly populations
- Recognize ageist thinking and ageist attitudes in individuals and institutions
- Identify risks factors and outcomes regarding mistreatment and abuse of elderly individuals
Aging comes with many challenges. The loss of independence is one potential part of the process, as are diminished physical ability and age discrimination. The term senescence refers to the aging process, including biological, emotional, intellectual, social, and spiritual changes. This section discusses some of the challenges we encounter during this process.
As already observed, many older adults remain highly self-sufficient. Others require more care. Because the elderly typically no longer hold jobs, finances can be a challenge. And due to cultural misconceptions, older people can be targets of ridicule and stereotypes. The elderly face many challenges in later life, but they do not have to enter old age without dignity.
Poverty
For many people in the United States, growing older once meant living with less income. In 1960, almost 35 percent of the elderly existed on poverty-level incomes. A generation ago, the nation’s oldest populations had the highest risk of living in poverty.
At the start of the twenty-first century, the older population was putting an end to that trend. Among people over sixty-five years old, the poverty rate fell from 30 percent in 1967 to 9.7 percent in 2008, well below the national average of 13.2 percent (U.S. Census Bureau 2009). However, given the subsequent recession, which severely reduced the retirement savings of many while taxing public support systems, how are the elderly affected? According to the Kaiser Commission on Medicaid and the Uninsured, the national poverty rate among the elderly had risen to 14 percent by 2010 (Urban Institute and Kaiser Commission 2010).
Before the recession hit, what had changed to cause a reduction in poverty among the elderly? What social patterns contributed to the shift? For several decades, a greater number of women joined the workforce. More married couples earned double incomes during their working years and saved more money for their retirement. Private employers and governments began offering better retirement programs. By 1990, senior citizens reported earning 36 percent more income on average than they did in 1980; that was five times the rate of increase for people under age thirty-five (U.S. Census Bureau 2009).
In addition, many people were gaining access to better healthcare. New trends encouraged people to live more healthful lifestyles by placing an emphasis on exercise and nutrition. There was also greater access to information about the health risks of behaviors such as cigarette smoking, alcohol consumption, and drug use. Because they were healthier, many older people continue to work past the typical retirement age and provide more opportunity to save for retirement. Will these patterns return once the recession ends? Sociologists will be watching to see. In the meantime, they are realizing the immediate impact of the recession on elderly poverty.
During the recession, older people lost some of the financial advantages that they’d gained in the 1980s and 1990s. From October 2007 to October 2009 the values of retirement accounts for people over age fifty lost 18 percent of their value. The sharp decline in the stock market also forced many to delay their retirement (Administration on Aging 2009).
Ageism
Driving to the grocery store, Peter, twenty-three years old, got stuck behind a car on a four-lane main artery through his city’s business district. The speed limit was thirty-five miles per hour, and while most drivers sped along at forty to forty-five mph, the driver in front of him was going the minimum speed. Peter tapped on his horn. He tailgated the driver. Finally, Peter had a chance to pass the car. He glanced over. Sure enough, Peter thought, a gray-haired old man guilty of “DWE,” driving while elderly.
At the grocery store, Peter waited in the checkout line behind an older woman. She paid for her groceries, lifted her bags of food into her cart, and toddled toward the exit. Peter, guessing her to be about eighty years old, was reminded of his grandmother. He paid for his groceries and caught up with her.
“Can I help you with your cart?” he asked.
“No, thank you. I can get it myself,” she said and marched off toward her car.
Peter’s responses to both older people, the driver and the shopper, were prejudiced. In both cases, he made unfair assumptions. He assumed the driver drove cautiously simply because the man was a senior citizen, and he assumed the shopper needed help carrying her groceries just because she was an older woman.
Responses like Peter’s toward older people are fairly common. He didn’t intend to treat people differently based on personal or cultural biases, but he did. Ageism is discrimination (when someone acts on a prejudice) based on age. Dr. Robert Butler coined the term in 1968, noting that ageism exists in all cultures (Brownell). Ageist attitudes and biases based on stereotypes reduce elderly people to inferior or limited positions.
Ageism can vary in severity. Peter’s attitudes are probably seen as fairly mild, but relating to the elderly in ways that are patronizing can be offensive. When ageism is reflected in the workplace, in healthcare, and in assisted-living facilities, the effects of discrimination can be more severe. Ageism can make older people fear losing a job, feel dismissed by a doctor, or feel a lack of power and control in their daily living situations.
In early societies, the elderly were respected and revered. Many preindustrial societies observed gerontocracy, a type of social structure wherein the power is held by a society’s oldest members. In some countries today, the elderly still have influence and power and their vast knowledge is respected. Reverence for the elderly is still a part of some cultures, but it has changed in many places because of social factors.
In many modern nations, however, industrialization contributed to the diminished social standing of the elderly. Today wealth, power, and prestige are also held by those in younger age brackets. The average age of corporate executives was fifty-nine years old in 1980. In 2008, the average age had lowered to fifty-four years old (Stuart 2008). Some older members of the workforce felt threatened by this trend and grew concerned that younger employees in higher level positions would push them out of the job market. Rapid advancements in technology and media have required new skill sets that older members of the workforce are less likely to have.
Changes happened not only in the workplace but also at home. In agrarian societies, a married couple cared for their aging parents. The oldest members of the family contributed to the household by doing chores, cooking, and helping with child care. As economies shifted from agrarian to industrial, younger generations moved to cities to work in factories. The elderly began to be seen as an expensive burden. They did not have the strength and stamina to work outside the home. What began during industrialization, a trend toward older people living apart from their grown children, has become commonplace. As you saw in the opening, children of older people can also feel guilt, sadness, and sometimes anger at both taking care of aging parents and with accepting that their parents are losing their abilities. Living apart, especially if an older person is moved to a nursing home or other facility, can often exacerbate these issues.
Mistreatment and Abuse
Mistreatment and abuse of the elderly is a major social problem. As expected, with the biology of aging, the elderly sometimes become physically frail. This frailty renders them dependent on others for care—sometimes for small needs like household tasks, and sometimes for assistance with basic functions like eating and toileting. Unlike a child, who also is dependent on another for care, an elder is an adult with a lifetime of experience, knowledge, and opinions—a more fully developed person. This makes the care-providing situation more complex.
Elder abuse occurs when a caretaker intentionally deprives an older person of care or harms the person in his or her charge. Caregivers may be family members, relatives, friends, health professionals, or employees of senior housing or nursing care. The elderly may be subject to many different types of abuse.
In a 2009 study on the topic led by Dr. Ron Acierno, the team of researchers identified five major categories of elder abuse: 1) physical abuse, such as hitting or shaking, 2) sexual abuse, including rape and coerced nudity, 3) psychological or emotional abuse, such as verbal harassment or humiliation, 4) neglect or failure to provide adequate care, and 5) financial abuse or exploitation (Acierno 2010).
The National Center on Elder Abuse (NCEA), a division of the U.S. Administration on Aging, also identifies abandonment and self-neglect as types of abuse. Table 13.2 shows some of the signs and symptoms that the NCEA encourages people to notice.
| Type of Abuse | Signs and Symptoms |
|---|---|
| Physical abuse | Bruises, untreated wounds, sprains, broken glasses, lab findings of medication overdose |
| Sexual abuse | Bruises around breasts or genitals, torn or bloody underclothing, unexplained venereal disease |
| Emotional/psychological abuse | Being upset or withdrawn, unusual dementia-like behavior (rocking, sucking) |
| Neglect | Poor hygiene, untreated bed sores, dehydration, soiled bedding |
| Financial | Sudden changes in banking practices, inclusion of additional names on bank cards, abrupt changes to will |
| Self-neglect | Untreated medical conditions, unclean living area, lack of medical items like dentures or glasses |
How prevalent is elder abuse? Two recent U.S. studies found that roughly one in ten elderly people surveyed had suffered at least one form of elder abuse. Some social researchers believe elder abuse is underreported and that the number may be higher. The risk of abuse also increases in people with health issues such as dementia (Kohn and Verhoek-Oftedahl 2011). Older women were found to be victims of verbal abuse more often than their male counterparts.
In Acierno’s study, which included a sample of 5,777 respondents aged sixty and older, 5.2 percent of respondents reported financial abuse, 5.1 percent said they’d been neglected, and 4.6 endured emotional abuse (Acierno 2010). The prevalence of physical and sexual abuse was lower at 1.6 and 0.6 percent, respectively (Acierno 2010).
Other studies have focused on the caregivers to the elderly in an attempt to discover the causes of elder abuse. Researchers identified factors that increased the likelihood of caregivers perpetrating abuse against those in their care. Those factors include inexperience, having other demands such as jobs (for those who weren’t professionally employed as caregivers), caring for children, living full-time with the dependent elder, and experiencing high stress, isolation, and lack of support (Kohn and Verhoek-Oftedahl 2011).
A history of depression in the caregiver was also found to increase the likelihood of elder abuse. Neglect was more likely when care was provided by paid caregivers. Many of the caregivers who physically abused elders were themselves abused—in many cases, when they were children. Family members with some sort of dependency on the elder in their care were more likely to physically abuse that elder. For example, an adult child caring for an elderly parent while at the same time depending on some form of income from that parent, is considered more likely to perpetrate physical abuse (Kohn and Verhoek-Oftedahl 2011).
A survey in Florida found that 60.1 percent of caregivers reported verbal aggression as a style of conflict resolution. Paid caregivers in nursing homes were at a high risk of becoming abusive if they had low job satisfaction, treated the elderly like children, or felt burnt out (Kohn and Verhoek-Oftedahl 2011). Caregivers who tended to be verbally abusive were found to have had less training, lower education, and higher likelihood of depression or other psychiatric disorders. Based on the results of these studies, many housing facilities for seniors have increased their screening procedures for caregiver applicants.
BIG PICTURE
World War II Veterans
World War II was a defining event in recent human history, and set the stage for America to become an economic and military superpower. Over 16 million Americans served in the war—an enormous amount on any scale, but especially significant considering that the U.S. had almost 200 million fewer people than it does today. That sizable and significant group is aging. Many are in their eighties and nineties, and many others have already passed on. Of the 16 million, less than 300,000 are alive. Data suggest that by 2036, there will be no living veterans of WWII (U.S. Department of Veteran Affairs).
When these veterans came home from the war and ended their service, little was known about posttraumatic stress disorder (PTSD). These heroes did not receive the mental and physical healthcare that could have helped them. As a result, many of them, now in old age, are dealing with the effects of PTSD. Research suggests a high percentage of World War II veterans are plagued by flashback memories and isolation, and that many “self-medicate” with alcohol.
Research has found that veterans of any conflict are more than twice as likely as nonveterans to commit suicide, with rates highest among the oldest veterans. Reports show that WWII-era veterans are four times as likely to take their own lives as people of the same age with no military service (Glantz 2010).
In May 2004, the National World War II Memorial in Washington, DC, was completed and dedicated to honor those who served during the conflict. Dr. Earl Morse, a physician and retired Air Force captain, treated many WWII veterans. He encouraged them to visit the memorial, knowing it could help them heal. Many WWII veterans expressed interest in seeing the memorial. Unfortunately, many were in their eighties and were neither physically nor financially able to travel on their own. Dr. Morse arranged to personally escort some of the veterans and enlisted volunteer pilots who would pay for the flights themselves. He also raised money, insisting the veterans pay nothing. By the end of 2005, 137 veterans, many using wheelchairs, had made the trip. The Honor Flight Network was up and running.
As of 2017, the Honor Flight Network had flown more than 200,000 U.S. veterans of World War II, the Korean War, and the Vietnam War to Washington. The round-trip flights leave for day-long trips from over 140 airports in thirty states, staffed by volunteers who care for the needs of the elderly travelers (Honor Flight Network 2021).
Key Terms
- activity theory
- a theory which suggests that for individuals to enjoy old age and feel satisfied, they must maintain activities and find a replacement for the statuses and associated roles they have left behind as they aged
- age stratification theory
- a theory which states that members of society are stratified by age, just as they are stratified by race, class, and gender
- ageism
- discrimination based on age
- baby Boomers
- people in the United States born between approximately 1946 and 1964
- centenarians
- people 100 years old or older
- cohort
- a group of people who share a statistical or demographic trait
- continuity theory
- a theory which states that the elderly make specific choices to maintain consistency in internal (personality structure, beliefs) and external structures (relationships), remaining active and involved throughout their elder years
- dependency ratio
- the number of nonproductive citizens (young, disabled, elderly) to productive working citizens
- disengagement theory
- a theory which suggests that withdrawing from society and social relationships is a natural part of growing old
- elder abuse
- the act of a caretaker intentionally depriving an older person of care or harming the person in their charge
- exchange theory
- a theory which suggests that we experience an increased dependence as we age and must increasingly submit to the will of others, because we have fewer ways of compelling others to submit to us
- filial piety
- deference and respect to one’s parents and ancestors in all things
- geriatrics
- a medical specialty focusing on the elderly
- gerontocracy
- a type of social structure wherein the power is held by a society’s oldest members
- gerontology
- a field of science that seeks to understand the process of aging and the challenges encountered as seniors grow older
- gerotranscendence
- the idea that as people age, they transcend limited views of life they held in earlier times
- grief
- a psychological, emotional, and social response to the feelings of loss that accompanies death or a similar event
- hospice
- healthcare that treats terminally ill people by providing comfort during the dying process
- life course
- the period from birth to death, including a sequence of predictable life events
- life expectancy
- the number of years a newborn is expected to live
- modernization theory
- a theory which suggests that the primary cause of the elderly losing power and influence in society are the parallel forces of industrialization and modernization
- physician-assisted suicide
- the voluntary use of lethal medication provided by a medical doctor to end one’s life
- primary aging
- biological factors such as molecular and cellular changes
- secondary aging
- aging that occurs due to controllable factors like exercise and diet
- selective optimization with compensation theory
- a theory based on the idea that successful personal development throughout the life course and subsequent mastery of the challenges associated with everyday life are based on the components of selection, optimization, and compensation
- senescence
- the aging process, including biological, intellectual, emotional, social, and spiritual changes
- social gerontology
- a specialized field of gerontology that examines the social (and sociological) aspects of aging
- subculture of aging theory
- a theory that focuses on the shared community created by the elderly when they are excluded (due to age), voluntarily or involuntarily, from participating in other groups
- supercentenarians
- people 110 of age or older
- thanatology
- the systematic study of death and dying
- Section Summary
-
13.1 Who Are the Elderly? Aging in Society
The social study of aging uses population data and cohorts to predict social concerns related to aging populations. In the United States, the population is increasingly older (called “the graying of the United States”), especially due to the baby Boomer segment. Global studies on aging reveal a difference in life expectancy between core and peripheral nations as well as a discrepancy in nations’ preparedness for the challenges of increasing elderly populations.
13.2 The Process of Aging
Old age affects every aspect of human life: biological, social, and psychological. Although medical technology has lengthened life expectancies, it cannot eradicate aging and death. Cultural attitudes shape the way our society views old age and dying, but these attitudes shift and evolve over time.
13.3 Challenges Facing the Elderly
As people enter old age, they face challenges. Ageism, which involves stereotyping and discrimination against the elderly, leads to misconceptions about their abilities. Although elderly poverty has been improving for decades, many older people may be detrimentally affected by the 2008 recession. Some elderly people grow physically frail and, therefore, dependent on caregivers, which increases their risk of elder abuse.
13.4 Theoretical Perspectives on Aging
The three major sociological perspectives inform the theories of aging. Theories in the functionalist perspective focus on the role of elders in terms of the functioning of society as a whole. Theories in the conflict perspective concentrate on how elders, as a group, are at odds with other groups in society. And theories in the symbolic interactionist perspective focus on how elders’ identities are created through their interactions.
13.1 Who Are the Elderly? Aging in Society
1. In most countries, elderly women ______ than elderly men.
- are mistreated less
- live a few years longer
- suffer fewer health problems
- deal with issues of aging better
2. America’s baby Boomer generation has contributed to all of the following except:
- Social Security’s vulnerability
- improved medical technology
- Medicaid being in danger of going bankrupt
- rising Medicare budgets
3. The measure that compares the number of men to women in a population is ______.
- cohort
- sex ratio
- baby Boomer
- disengagement
4. The “graying of the United States” refers to ________.
- the increasing percentage of the population over sixty-five years old
- faster aging due to stress
- dissatisfaction with retirement plans
- increased health problems such as Alzheimer’s
5. What is the approximate median age of the United States?
- eighty-five
- sixty-five
- thirty-seven
- eighteen
13.2 The Process of Aging
6. Thanatology is the study of _____.
- life expectancy
- biological aging
- death and dying
- adulthood
7. In Erik Erikson’s developmental stages of life, with which challenge must older people struggle?
- Overcoming despair to achieve integrity
- Overcoming role confusion to achieve identity
- Overcoming isolation to achieve intimacy
- Overcoming shame to achieve autonomy
8. Who wrote the book On Death and Dying, outlining the five stages of grief?
- Ignatz Nascher
- Erik Erikson
- Elisabeth Kübler-Ross
- Carol Gilligan
9. For individual people of a certain culture, the life course is ________.
- the average age they will die
- the lessons they must learn
- the length of a typical bereavement period
- the typical sequence of events in their lives
10. In the United States, life expectancy rates in recent decades have ______.
- continued to gradually rise
- gone up and down due to global issues such as military conflicts
- lowered as healthcare improves
- stayed the same since the mid-1960s
13.3 Challenges Facing the Elderly
11. Today in the United States the poverty rate of the elderly is ______.
- lower than at any point in history
- increasing
- decreasing
- the same as that of the general population
12. Which action reflects ageism?
- Enabling WWII veterans to visit war memorials
- Speaking slowly and loudly when talking to someone over age sixty-five years old
- Believing that older people drive too slowly
- Living in a culture where elders are respected
13. Which factor most increases the risk of an elderly person suffering mistreatment?
- Bereavement due to widowhood
- Having been abusive as a younger adult
- Being frail to the point of dependency on care
- The ability to bestow a large inheritance on survivors
14. If elderly people suffer abuse, it is most often perpetrated by ______.
- spouses
- caregivers
- lawyers
- strangers
15. Veterans are two to four times more likely to ______ as people who did not serve in the military.
- be a victim of elder abuse
- commit suicide
- be concerned about financial stresses
- be abusive toward care providers
13.4 Theoretical Perspectives on Aging
16. Which assertion about aging in men would be made by a sociologist following the functionalist perspective?
- Men view balding as representative of a loss of strength.
- Men tend to have better retirement plans than women.
- Men have life expectancies three to five years shorter than women.
- Men who remain active after retirement play supportive community roles.
17. An older woman retires and completely changes her life. She is no longer raising children or working. However, she joins the YWCA to swim every day. She serves on the Friends of the Library board. She is part of a neighborhood group that plays Bunco on Saturday nights. Her situation most closely illustrates the ______ theory.
- activity
- continuity
- disengagement
- gerotranscendence
18. An older man retires from his job, stops golfing, and cancels his newspaper subscription. After his wife dies, he lives alone, loses touch with his children, and stops seeing old friends. His situation most closely illustrates the _______ theory.
- activity
- continuity
- disengagement
- gerotranscendence
19. What is the primary driver of modernization theory?
- Industrialization
- Aging
- Conflict
- Interactions
20. The Age Discrimination in Employment Act counteracts which theory?
- Modernization
- Conflict
- Disengagement
- Age stratification
13.1 Who Are the Elderly? Aging in Society
13.2 The Process of Aging
13.3 Challenges Facing the Elderly
13.4 Theoretical Perspectives on Aging
Further Research
13.1 Who Are the Elderly? Aging in Society
Gregory Bator founded the television show Graceful Aging and then developed a web site offering short video clips from the show. The purpose of Graceful Aging is to both inform and entertain, with clips on topics such as sleep, driving, health, safety, and legal issues. Bator, a lawyer, works on counseling seniors about their legal needs. Log onto Graceful Aging for a visual understanding of aging.
13.2 The Process of Aging
Read the article “A Study of Sexuality and Health among Older Adults in the United States”.
13.3 Challenges Facing the Elderly
Veterans who served in the U.S. Armed Forces during various conflicts represent cohorts. Veterans share certain aspects of life in common. To find information on veteran populations and how they are aging, study the information on the web site of the U.S. Department of Veterans Affairs.
Learn more about the Honor Flight Network, the organization offering trips to national war memorials in Washington, DC, at no cost to the veterans.
13.4 Theoretical Perspectives on Aging
New Dynamics of Aging is a web site produced by an interdisciplinary team at the University of Sheffield. It is supposedly the largest research program on aging in the United Kingdom to date. In studying the experiences of aging and factors that shape aging, including behaviors, biology, health, culture, history, economics, and technology, researchers are promoting healthy aging and helping dispel stereotypes. Learn more by logging onto it’s website here.
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Sharpe, P.A. 1995. “Older Women and Health Services: Moving from Ageism Toward Empowerment.” Women & Health 22:9–23.
Spector-Mersel, Gabriela. 2006. “Never-Aging Stories: Western Hegemonic Masculinity Scripts.” Journal of Gender Studies 15:67–82.
United Nations. 2020. “World Population Aging, 2019 Highlights.” United Nations. (https://www.un.org/en/development/desa/population/publications/pdf/ageing/WorldPopulationAgeing2019-Highlights.pdf
Whitbourne, Susan and Stacey Whitbourne. 2010. Adult Development and Aging: Biopsychosocial Perspectives. 4th ed. Hoboken, NJ: Wiley.
13.3 Challenges Facing the Elderly
Acierno, R., Melba A. Hernandez, Ananda B. Amstadter, Heidi S. Resnick, Kenneth Steve, Wendy Muzzy, and Dean G. Kilpatrick. 2010. “Prevalence and Correlates of Emotional, Physical, Sexual, Financial Abuse and Potential Neglect in the United States.” American Journal of Public Health 100:292–7.
Administration on Aging. 2009. “Data Sources on the Impact of the 2008 Financial Crisis on the Economic Well-being of Older Americans Aging Forum Report Issue #1.” Retrieved February 13, 2012 (http://www.agingstats.gov/Main_Site/docs/DSOA_Aging_Brief.pdf).
Brownell, Patricia. 2010. “Social Issues and Social Policy Response to Abuse and Neglect of Older Adults.” Pp. 1–16 in Aging, Ageism and Abuse: Moving from Awareness to Action, edited by G. Gutman and C. Spencer. Amsterdam, the Netherlands: Elsevier.
Glantz, Aaron. 2010. “Suicide Rates Soar among WWII Vets, Records Show.” The Bay Citizen, November 11. Retrieved February 27, 2012 (http://www.baycitizen.org/veterans/story/suicide-rates-soar-among-wwii-vets/comments/#comments).
Honor Flight Network. 2011. Retrieved September 22, 2011 (http://www.honorflight.org/).
Kohn, Robert, and Wendy Verhoek-Oftedahl. 2011. “Caregiving and Elder Abuse.” Medicine & Health Rhode Island 94(2):47–49.
National Center for Veterans Analysis and Statistics. 2011. “VA Benefits and Health Care Utilization.” November 9. Retrieved February 13, 2012 (http://www.va.gov/Vetdata/docs/Quickfacts/4x6_fall_11_sharepoint_Final.pdf).
National Center of Elder Abuse. 2011. “Major Types of Elder Abuse.” Retrieved January 21, 2012 (http://ncea.aoa.gov/FAQ/Type_Abuse/).
Stuart, Spencer. 2008. “Leading CEOs: A Statistical Snapshot of S&P 500 Leaders.” Retrieved February 13, 2012 (http://content.spencerstuart.com/sswebsite/pdf/lib/2005_CEO_Study_JS.pdf).
Urban Institute and Kaiser Commission. 2010. “Poverty Rate by Age.” Retrieved January 21, 2012 (http://www.statehealthfacts.org/comparebar.jsp?ind=10&cat=1″).
U.S. Census Bureau. 2009. “Webinar on 2008 Income, Poverty, and Health Insurance Estimates from the Current Population Survey.” Retrieved February 13, 2012 (http://www.census.gov/newsroom/releases/archives/news_conferences/2009-09-10_remarks_johnson.html).
U.S. Department of Veteran Affairs. 2010. “Veteran Population Projections FY 2000 to FY2036.” December. Retrieved February 13, 2012 (http://www.va.gov/vetdata/docs/quickfacts/Population-slideshow.pdf).
13.4 Theoretical Perspectives on Aging
Abner, Carrie. 2006. “Graying Prisons: States Face Challenges of an Aging Inmate Population.” State News, November/December.
Atchley, R.C. 1971. “Retirement and Leisure Participation: Continuity or Crisis?” The Gerontologist 11:13–17.
Atchley, R.C. 1989. “A Continuity Theory of Normal Aging.” The Gerontologist 29:183–190.
Baltes, Paul, and Margret Baltes, eds. 1990. Successful Aging: Perspectives from The Behavioral Sciences. New York: Press Syndicate of the University of Cambridge.
Cowgill, D.O. and L.D. Holmes, eds. 1972. Aging and Modernization. New York: Appleton-Century-Crofts.
Crosnoe, Robert, and Glen H. Elder. 2002. “Life Course Transitions, the Generational Stake, and Grandparent-Grandchild Relationships.” Journal of Marriage and Family 64(4):1089–1096.
Cumming, Elaine, and William Earl Henry. 1961. Growing Old. New York: Basic.
Dowd, James J. 1975. “Aging as Exchange: A Preface to Theory.” Journal of Gerontology 30:584–594.
Havinghurst, R.J. 1961. “Successful Aging.” The Gerontologist 1:8–13.
Havinghurst, Robert, Bernice Neugarten, and Sheldon Tobin. 1968. “Patterns of Aging.” Pp. 161–172 in Middle Age and Aging, edited by B. Neugarten. Chicago, IL: University of Chicago Press.
Hothschild, Arlie. 1975. “Disengagement Theory: A Critique and Proposal.” American Sociological Review 40:563–569.
Human Rights Watch. 2012. Old Behind Bars: The Aging Prison Population in the United States. Retrieved February 2, 2012 (http://www.hrw.org/reports/2012/01/27/old-behind-bars).
Leadership Conference. N.d. “Chapter Three: Race, Sentencing and the “Tough Crime” Movement.” Retrieved February 2, 2012 (http://www.civilrights.org/publications/justice-on-trial/sentencing.html).
Lemon, B., V. Bengtson, and J. Petersen. 1972. “An Exploration of the Activity Theory of Aging: Activity Types and Life Expectation among In-Movers to a Retirement Community.” Journal of Gerontology 27:511–23.
Li, Wiehua and Lewis, Nicole. 2020. “This Chart Shows Why the Prison Population Is So Vulnerable to COVID-19.” The Marshall Project. (https://www.themarshallproject.org/2020/03/19/this-chart-shows-why-the-prison-population-is-so-vulnerable-to-covid-19)
Reese, Hope. 2019. “What Should We Do About Our Aging Prison Population?” JSTOR Daily. (https://daily.jstor.org/what-should-we-do-about-our-aging-prison-population/)
Riley, Matilda While, Marilyn Johnson, and Anne Foner. 1972. Aging and Society. Volume III, A Sociology of Age Stratification. New York: Russell Sage Foundation.
Rose, Arnold. 1960. “The Subculture of the Aging: A Topic for Sociological Research.” The Gerontologist 2:123–127.
Tornstam Lars. 2005. Gerotranscendence: A Developmental Theory of Positive Aging. New York: Springer Publishing Company.
U.S. Census Bureau. 2011. Statistical Abstract 2011: Table 147. Retrieved February 13, 2012 (http://www.census.gov/compendia/statab/cats/health_nutrition/medicare_medicaid.html).
U.S. Equal Employment Opportunity Commission. 2012. “The Age Discrimination in Employment Act 1967 (ADEA).” Retrieved January 30, 2012 (http://www.eeoc.gov/laws/statutes/adea.cfm).
Warren, Jenifer. 2002. “The Graying of the Prisons.” Los Angeles Times, June 9. Retrieved February 2, 2012 (http://articles.latimes.com/2002/jun/09/local/me-cons9).
